BILL NUMBER: AB 2152	CHAPTERED  09/15/00

	CHAPTER   453
	FILED WITH SECRETARY OF STATE   SEPTEMBER 15, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 14, 2000
	PASSED THE ASSEMBLY   AUGUST 24, 2000
	PASSED THE SENATE   AUGUST 23, 2000
	AMENDED IN SENATE   AUGUST 18, 2000
	AMENDED IN ASSEMBLY   APRIL 13, 2000

INTRODUCED BY   Assembly Member Aroner

                        FEBRUARY 23, 2000

   An act to amend Section 14132 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2152, Aroner.  Medi-Cal:  durable medical equipment.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons, including those with disabilities, are provided
with health care services.  One of the benefits covered under the
Medi-Cal program is durable medical equipment, subject to utilization
controls.
   This bill would require that the utilization controls allow
authorization of durable medical equipment needed to assist a
disabled beneficiary in caring for a child for whom the disabled
beneficiary is a parent, stepparent, foster parent, or legal
guardian, subject to the availability of federal financial
participation.  It would also require the department to adopt
emergency regulations to define and establish criteria for assistive
durable medical equipment in accordance with specified provisions.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Under existing Medi-Cal program provisions relating to the
scope of health and medical care, as contained in Section 14059 of
the Welfare and Institutions Code, reference to "conditions that
interfere with normal activity" necessarily includes conditions that
interfere with the ability of a parent or other caretaker to care for
a child.
   (b) Section 14059.5 of the Welfare and Institutions Code provides
that under the Medi-Cal program, a service is considered medically
necessary when it is reasonably necessary to prevent significant
disability.
   (c) Conditions that interfere with the ability of a parent or
caretaker to care for a child constitute a severe disability within
the meaning of Section 14059.5 of the Welfare and Institutions Code.

  SEC. 2.  Section 14132 of the Welfare and Institutions Code is
amended to read:
   14132.  The following is the schedule of benefits under this
chapter:
   (a) Outpatient services are covered as follows:
   Physician, hospital or clinic outpatient, surgical center,
respiratory care, optometric, chiropractic, psychology, podiatric,
occupational therapy, physical therapy, speech therapy, audiology,
acupuncture to the extent federal matching funds are provided for
acupuncture, and services of persons rendering treatment by prayer or
healing by spiritual means in the practice of any church or
religious denomination insofar as these can be encompassed by federal
participation under an approved plan, subject to utilization
controls.
   (b) Inpatient hospital services, including, but not limited to,
physician and podiatric services, physical therapy and occupational
therapy, are covered subject to utilization controls.
   (c) Nursing facility services, subacute care services, and
services provided by any category of intermediate care facility for
the developmentally disabled, including podiatry, physician, nurse
practitioner services, and prescribed drugs, as described in
subdivision (d), are covered subject to utilization controls.
Respiratory care, physical therapy, occupational therapy, speech
therapy, and audiology services for patients in nursing facilities
and any category of intermediate care facility for the
developmentally disabled are covered subject to utilization controls.

   (d) Purchase of prescribed drugs is covered subject to the
Medi-Cal List of Contract Drugs and utilization controls.
   (e) Outpatient dialysis services and home hemodialysis services,
including physician services, medical supplies, drugs and equipment
required for dialysis, are covered, subject to utilization controls.

   (f) Anesthesiologist services when provided as part of an
outpatient medical procedure, nurse anesthetist services when
rendered in an inpatient or outpatient setting under conditions set
forth by the director, outpatient laboratory services, and X-ray
services are covered, subject to utilization controls.  Nothing in
this subdivision shall be construed to require prior authorization
for anesthesiologist services provided as part of an outpatient
medical procedure or for portable X-ray services in a nursing
facility or any category of intermediate care facility for the
developmentally disabled.
   (g) Blood and blood derivatives are covered.
   (h) (1) Emergency and essential diagnostic and restorative dental
services, except for orthodontic, fixed bridgework, and partial
dentures that are not necessary for balance of a complete artificial
denture, are covered, subject to utilization controls.  The
utilization controls shall allow emergency and essential diagnostic
and restorative dental services and prostheses that are necessary to
prevent a significant disability or to replace previously furnished
prostheses which are lost or destroyed due to circumstances beyond
the beneficiary's control.  The department's utilization controls
shall not require X-rays as a condition of reimbursement for fillings
for children under 18 years of age.  Notwithstanding the foregoing,
the director may by regulation provide for certain fixed artificial
dentures necessary for obtaining employment or for medical conditions
which preclude the use of removable dental prostheses, and for
orthodontic services in cleft palate deformities administered by the
department's California Children Services Program.
   (2) For persons 21 years of age or older, the services specified
in paragraph (1) shall be provided subject to the following
conditions:
   (A) Periodontal treatment is not a benefit.
   (B) Endodontic therapy is not a benefit except for vital
pulpotomy.
   (C) Laboratory processed crowns are not a benefit.
   (D) Removable prosthetics shall be a benefit only for patients as
a requirement for employment.
   (E) The director may, by regulation, provide for the provision of
fixed artificial dentures that are necessary for medical conditions
that preclude the use of removable dental prostheses.
   (F) Notwithstanding the conditions specified in subparagraphs (A)
to (E), inclusive, the department may approve services for persons
with special medical disorders subject to utilization review.
   (3) Paragraph (2) shall become inoperative July 1, 1995.
   (i) Medical transportation is covered, subject to utilization
controls.
   (j) Home health care services are covered, subject to utilization
controls.
   (k) Prosthetic and orthotic devices and eyeglasses are covered,
subject to utilization controls.  Utilization controls shall allow
replacement of prosthetic and orthotic devices and eyeglasses
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control.  Frame styles for eyeglasses replaced
pursuant to this subdivision shall not change more than once every
two years, unless the department so directs.
   Orthopedic and conventional shoes are covered when provided by a
prosthetic and orthotic supplier on the prescription of a physician
and when at least one of the shoes will be attached to a prosthesis
or brace, subject to utilization controls.  Modification of stock
conventional or orthopedic shoes when medically indicated, is covered
subject to utilization controls.  When there is a clearly
established medical need that cannot be satisfied by the modification
of stock conventional or orthopedic shoes, custom-made orthopedic
shoes are covered, subject to utilization controls.
   (l) Hearing aids are covered, subject to utilization controls.
Utilization controls shall allow replacement of hearing aids
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control.
   (m) Durable medical equipment and medical supplies are covered,
subject to utilization controls.  The utilization controls shall
allow the replacement of durable medical equipment and medical
supplies when necessary because of loss or destruction due to
circumstances beyond the beneficiary's control.  The utilization
controls shall allow authorization of durable medical equipment
needed to  assist a disabled beneficiary in caring for a child for
whom the disabled beneficiary is a parent, stepparent, foster parent,
or legal guardian, subject to the availability of federal financial
participation.  The department shall adopt emergency regulations to
define and establish criteria for assistive durable medical equipment
in accordance with the rulemaking provisions of the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code).
   (n) Family planning services are covered, subject to utilization
controls.
   (o) Inpatient intensive rehabilitation hospital services,
including respiratory rehabilitation services, in a general acute
care hospital are covered, subject to utilization controls, when
either of the following criteria are met:
   (1) A patient with a permanent disability or severe impairment
requires an inpatient intensive rehabilitation hospital program as
described in Section 14064 to develop function beyond the limited
amount that would occur in the normal course of recovery.
   (2) A patient with a chronic or progressive disease requires an
inpatient intensive rehabilitation hospital program as described in
Section 14064 to maintain the patient's present functional level as
long as possible.
   (p) Adult day health care is covered in accordance with Chapter
8.7 (commencing with Section 14520).
   (q) (1) Application of fluoride, or other appropriate fluoride
treatment as defined by the department, other prophylaxis treatment
for children 17 years of age and under, are covered.
   (2) All dental hygiene services provided by a registered dental
hygienist in alternative practice pursuant to Sections 1768 and 1770
of the Business and Professions Code may be covered as long as they
are within the scope of Denti-Cal benefits and they are necessary
services provided by a registered dental hygienist in alternative
practice.
   (r) (1) Paramedic services performed by a city, county, or special
district, or pursuant to a contract with a city, county, or special
district, and pursuant to a program established under Article 3
(commencing with Section 1480) of Chapter 2.5 of Division 2 of the
Health and Safety Code by a paramedic certified pursuant to that
article, and consisting of defibrillation and those services
specified in subdivision (3) of Section 1482 of the article.
   (2) All providers enrolled under this subdivision shall satisfy
all applicable statutory and regulatory requirements for becoming a
Medi-Cal provider.
   (3) This subdivision shall be implemented only to the extent
funding is available under Section 14106.6.
   (s) In-home medical care services are covered when medically
appropriate and subject to utilization controls, for beneficiaries
who would otherwise require care for an extended period of time in an
acute care hospital at a cost higher than in-home medical care
services.  The director shall have the authority under this section
to contract with organizations qualified to provide in-home medical
care services to those persons.  These services may be provided to
patients placed in shared or congregate living arrangements, if a
home setting is not medically appropriate or available to the
beneficiary.  As used in this section, "in-home medical care service"
includes utility bills directly attributable to continuous, 24-hour
operation of life-sustaining medical equipment, to the extent that
federal financial participation is available.
   As used in this subdivision, in-home medical care services,
include, but are not limited to:
   (1) Level of care and cost of care evaluations.
   (2) Expenses, directly attributable to home care activities, for
materials.
   (3) Physician fees for home visits.
   (4) Expenses directly attributable to home care activities for
shelter and modification to shelter.
   (5) Expenses directly attributable to additional costs of special
diets, including tube feeding.
   (6) Medically related personal services.
   (7) Home nursing education.
   (8) Emergency maintenance repair.
   (9) Home health agency personnel benefits which permit coverage of
care during periods when regular personnel are on vacation or using
sick leave.
   (10) All services needed to maintain antiseptic conditions at
stoma or shunt sites on the body.
   (11) Emergency and nonemergency medical transportation.
   (12) Medical supplies.
   (13) Medical equipment, including, but not limited to, scales,
gurneys, and equipment racks suitable for paralyzed patients.
   (14) Utility use directly attributable to the requirements of home
care activities which are in addition to normal utility use.
   (15) Special drugs and medications.
   (16) Home health agency supervision of visiting staff which is
medically necessary, but not included in the home health agency rate.

   (17) Therapy services.
   (18) Household appliances and household utensil costs directly
attributable to home care activities.
   (19) Modification of medical equipment for home use.
   (20) Training and orientation for use of life support systems,
including, but not limited to, support of respiratory functions.
   (21) Respiratory care practitioner services as defined in Sections
3702 and 3703 of the Business and Professions Code, subject to
prescription by a physician and surgeon.
   Beneficiaries receiving in-home medical care services are entitled
to the full range of services within the Medi-Cal scope of benefits
as defined by this section, subject to medical necessity and
applicable utilization control.  Services provided pursuant to this
subdivision, which are not otherwise included in the Medi-Cal
schedule of benefits, shall be available only to the extent that
federal financial participation for these services is available in
accordance with a home- and community-based services waiver.
   (t) Home- and community-based services approved by the United
States Department of Health and Human Services may be covered to the
extent that federal financial participation is available for those
services under waivers granted in accordance with Section 1396n of
Title 42 of the United States Code.  The director may seek waivers
for any or all home- and community-based services approvable under
Section 1396n of Title 42 of the United States Code.  Coverage for
those services shall be limited by the terms, conditions, and
duration of the federal waivers.
   The department shall submit a report, as provided in Section 28 of
the 1982 Budget Act, 30 days prior to providing these services as
Medi-Cal benefits.  The report shall be submitted to the Joint
Legislative Budget Committee and the fiscal committees and shall
address the cost effectiveness of services provided pursuant to this
subdivision.
   (u) Comprehensive perinatal services, as provided through an
agreement with a health care provider designated in Section 14134.5
and meeting the standards developed by the department pursuant to
Section 14134.5, subject to utilization controls.
   The department shall seek any federal waivers necessary to
implement the provisions of this subdivision.  The provisions for
which appropriate federal waivers cannot be obtained shall not be
implemented.  Provisions for which waivers are obtained or for which
waivers are not required shall be implemented notwithstanding any
inability to obtain federal waivers for the other provisions.  No
provision of this subdivision shall be implemented unless matching
funds from Subchapter XIX (commencing with Section 1396) of Chapter 7
of Title 42 of the United States Code are available.
   (v) Early and periodic screening, diagnosis, and treatment for any
individual under 21 years of age is covered, consistent with the
requirements of Subchapter XIX (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
   (w) Hospice service which is Medicare-certified hospice service is
covered, subject to utilization controls.  Coverage shall be
available only to the extent that no additional net program costs are
incurred.
   (x) When a claim for treatment provided to a beneficiary includes
both services which are authorized and reimbursable under this
chapter, and services which are not reimbursable under this chapter,
that portion of the claim for the treatment and services authorized
and reimbursable under this chapter shall be payable.
   (y) Home- and community-based services approved by the United
States Department of Health and Human Services for beneficiaries with
a diagnosis of AIDS or ARC, who require intermediate care or a
higher level of care.
   Services provided pursuant to a waiver obtained from the Secretary
of the United States Department of Health and Human Services
pursuant to this subdivision, and which are not otherwise included in
the Medi-Cal schedule of benefits, shall be available only to the
extent that federal financial participation for these services is
available in accordance with the waiver, and subject to the terms,
conditions, and duration of the waiver.  These services shall be
provided to individual beneficiaries in accordance with the client's
needs as identified in the plan of care, and subject to medical
necessity and applicable utilization control.
   The director may under this section contract with organizations
qualified to provide, directly or by subcontract, services provided
for in this subdivision to eligible beneficiaries.  Contracts or
agreements entered into pursuant to this division shall not be
subject to the Public Contract Code.
   (z) Respiratory care when provided in organized health care
systems as defined in Section 3701 of the Business and Professions
Code, and as an in-home medical service as outlined in subdivision
(s).
   (aa) (1) There is hereby established in the department, a program
to provide comprehensive clinical family planning services to any
person who has a family income at or below 200 percent of the federal
poverty level, as revised annually, and who is eligible to receive
these services pursuant to the waiver identified in paragraph (2).
This program shall be known as the Family Planning, Access, Care, and
Treatment (Family PACT) Waiver Program.
   (2) The department shall seek a waiver for a program to provide
comprehensive clinical family planning services as described in
paragraph (8).  The program shall be operated only in accordance with
the waiver and the statutes and regulations in paragraph (4) and
subject to the terms, conditions, and duration of the waiver.  The
services shall be provided under the program only if the waiver is
approved by the federal Health Care Financing Administration in
accordance with Section 1396n of Title 42 of the United States Code
and only to the extent that federal financial participation is
available for the services.
   (3) Solely for the purposes of the waiver and notwithstanding any
other provision of law, the collection and use of an individual's
social security number shall be necessary only to the extent required
by federal law.
   (4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005, and
24013, and any regulations adopted under these statutes shall apply
to the program provided for under this subdivision.  No other
provision of law under the Medi-Cal program or the State-Only Family
Planning Program shall apply to the program provided for under this
subdivision.
   (5) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, without taking regulatory action, the
provisions of the waiver after its approval by the federal Health
Care Financing Administration and the provisions of this section by
means of an all-county letter or similar instruction to providers.
Thereafter, the department shall adopt regulations to implement this
section and the approved waiver in accordance with the requirements
of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
3 of Title 2 of the Government Code.  Beginning six months after the
effective date of the act adding this subdivision, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
   (6) In the event that the Department of Finance determines that
the program operated under the authority of the waiver described in
paragraph (2) is no longer cost-effective, this subdivision shall
become inoperative on the first day of the first month following the
issuance of a 30-day notification of that determination in writing by
the Department of Finance to the chairperson in each house that
considers appropriations, the chairpersons of the committees, and the
appropriate subcommittees in each house that considers the State
Budget, and the Chairperson of the Joint Legislative Budget
Committee.
   (7) If this subdivision ceases to be operative, all persons who
have received or are eligible to receive comprehensive clinical
family planning services pursuant to the waiver described in
paragraph (2) shall receive family planning services under the
Medi-Cal program pursuant to subdivision (n) if they are otherwise
eligible for Medi-Cal with no share of cost, or shall receive
comprehensive clinical family planning services under the program
established in Division 24 (commencing with Section 24000) either if
they are eligible for Medi-Cal with a share of cost or if they are
otherwise eligible under Section 24003.
   (8) For purposes of this subdivision, "comprehensive clinical
family planning services" means the process of establishing
objectives for the number and spacing of children, and selecting the
means by which those objectives may be achieved.  These means include
a broad range of acceptable and effective methods and services to
limit or enhance fertility, including contraceptive methods, federal
Food and Drug Administration approved contraceptive drugs, devices,
and supplies, natural family planning, abstinence methods, and basic,
limited fertility management.  Comprehensive clinical family
planning services include, but are not limited to, preconception
counseling, maternal and fetal health counseling, general
reproductive health care, including diagnosis and treatment of
infections and conditions, including cancer, that threaten
reproductive capability, medical family planning treatment and
procedures, including supplies and followup, and informational,
counseling, and educational services.  Comprehensive clinical family
planning services shall not include abortion, pregnancy testing
solely for the purposes of referral for abortion or services
ancillary to abortions, or pregnancy care that is not incident to the
diagnosis of pregnancy.  Comprehensive clinical family planning
services shall be subject to utilization control and include all of
the following:
   (A) Family planning related services and male and female
sterilization.  Family planning services for men and women shall
include emergency services and services for complications directly
related to the contraceptive method, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies,
and followup, consultation, and referral services, as indicated,
which may require treatment authorization requests.
   (B) All United States Department of Agriculture, federal Food and
Drug Administration approved contraceptive drugs, devices, and
supplies that are in keeping with current standards of practice and
from which the individual may choose.
   (C) Culturally and linguistically appropriate health education and
counseling services, including informed consent, that include all of
the following:
   (i) Psychosocial and medical aspects of contraception.
   (ii) Sexuality.
   (iii) Fertility.
   (iv) Pregnancy.
   (v) Parenthood.
   (vi) Infertility.
   (vii) Reproductive health care.
   (viii) Preconception and nutrition counseling.
   (ix) Prevention and treatment of sexually transmitted infection.
   (x) Use of contraceptive methods, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies.
   (xi) Possible contraceptive consequences and followup.
   (xii) Interpersonal communication and negotiation of relationships
to assist individuals and couples in effective contraceptive method
use and planning families.
   (D) A comprehensive health history, updated at next periodic visit
(between 11 and 24 months after initial examination) that includes a
complete obstetrical history, gynecological history, contraceptive
history, personal medical history, health risk factors, and family
health history, including genetic or hereditary conditions.
   (E) A complete physical examination on initial and subsequent
periodic visits.
